The Western journal of medicine
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Historical Article
Trench foot--a study in military-medical responsiveness in the Great War, 1914-1918.
Along the nearly 15,000 miles of trenches on the western front in the Great War of 1914-1918, a condition known as "trench foot" caused serious attrition among the fighting troops and resulted in swollen limbs, impaired sensory nerves, inflammation, and even loss of tissue through gangrene. Physicians, sanitarians, and military officers explored numerous theories regarding etiology and treatment before focusing on a combined regimen of common-sense hygiene and strict military discipline.
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After tobacco, marijuana is the most widely smoked substance in our society. Studies conducted within the past 15 years in animals, isolated tissues, and humans indicate that marijuana smoke can injure the lungs. ⋯ New evidence is emerging implicating smoked cocaine as a cause of acute respiratory tract symptoms, lung dysfunction, and, in some cases, serious, life-threatening acute lung injury. A strong physician message to users of marijuana, cocaine, or both concerning the harmful effects of these smoked substances on the lungs and other organs may persuade some of them, especially those with drug-related respiratory complications, to quit smoking.
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There is increased concern about the effects of sleep deprivation on physician performance. We administered four standard tests of cognitive function to 23 university hospital house staff. Each physician served as his or her own control, and the tests were administered at rest, after a night on call, and after a night of sleep for recovery. ⋯ Statistically significant deterioration occurred in 3 of the 4 tests after a night on call. Even physicians acclimated to sleep deprivation on a regular, every-third-or-fourth-night basis showed functional impairment. The results have implications for patient care under conditions where house staff are stressed by sleep deprivation and prolonged fatigue.
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The use of wood stoves has increased greatly in the past decade, causing concern in many communities about the health effects of wood smoke. Wood smoke is known to contain such compounds as carbon monoxide, nitrogen oxides, sulfur oxides, aldehydes, polycyclic aromatic hydrocarbons, and fine respirable particulate matter. All of these have been shown to cause deleterious physiologic responses in laboratory studies in humans. ⋯ Fine particulate matter has been associated with decreased pulmonary function in children and with increased chronic lung disease in Nepal, where exposure to very high amounts of wood smoke occurs in residences. Wood smoke fumes, taken from both outdoor and indoor samples, have shown mutagenic activity in short-term bioassay tests. Because of the potential health effects of wood smoke, exposure to this source of air pollution should be minimal.
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Comparative Study
Understanding of elderly patients' resuscitation preferences by physicians and nurses.
We compared the understanding by family physicians and nurses of their elderly outpatients' preferences for cardiopulmonary resuscitation and mechanical ventilation under 3 scenarios reflecting varying qualities of life. Physicians and nurses correctly predicted patients' treatment preferences in from 59% to 84% and 53% to 78% of cases, respectively, for the various decisions. ⋯ Moreover, nurses and physicians did not significantly agree with one another in their predictions of patients' preferences for any of these decisions. These results suggest that while nurses' and physicians' perceptions of patients' preferences for life-sustaining treatment are not necessarily similar, neither nurses nor physicians systematically understand their elderly patients' resuscitation preferences.